Health Care Executives and Medical Ethics

By Vaux, Kenneth | The Hastings Center Report, November-December 1990 | Go to article overview

Health Care Executives and Medical Ethics


Vaux, Kenneth, The Hastings Center Report


Health Care Executives and Medical Ethics

A major social experiment underway in the state of Oregon prompted the professional society of health care executives to probe the opinions of their members on the right of all Americans to basic health care. In contrast to the current method of denying health care to latecomers or less articulate public aid recipients, the Oregon method is to publish a list of basic services to which everyone is entitled.

Is such an explicit rationing of health care a good idea? And, if so, how should we decide on what is basic? Are all persons entitled to basic health care or should some people, for example, the elderly, be limited in the kinds of health care made available to them? These constitute the core questions put to 576 randomly sampled health care executives affiliated with the American College of Health Care Executives, the oldest and largest group of senior executives in the U.S.

Fifty-six percent of respondents believe that setting priorities explicitly could improve the current overburdened and inadequate system of care for the poor. However, the executives believe that the process of setting explicit priorities should not necessarily stop people with discretionary income from purchasing any type of health care--whether effective or not. Seventy percent affirm that in a free country, people have a right to spend their own money in any legal way they choose, even for health services that provide little or no benefit.

What counts as basic care? The criteria the executives thought would be most helpful in determining a definition of basic were: (1) the probability that the service would achieve the desired results (62%); (2) the quality of life resulting from providing or not providing care (59%); (3) the economic costs of providing or not providing care (for example, giving a hip replacement to allow an arthritic to live independently) (58%); and (4) cost (55%).

The criterion of effectiveness, which was chosen most often, is echoed in other responses as well. For example, 58 percent agreed that efficacy should receive greater weight than equity in allocation decisions. Moreover, 57 percent thought that government and community leaders need to develop a plan that gives more resources to the root causes of poor health--poverty, poor housing, poor schools, and drug abuse--and fewer resources to curative health services. …

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